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#1 Troypants

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Posted 25 September 2021 - 01:18 AM

Hey guys, I have been perusing this site learning about the struggle people go through with this drug.

 

I'm very grateful to have a forum where to ask for advice and help.

 

I have been tapering off duloxetine for quite a while, I started with the alternating dose method from 120mg down to 30mg but needed to slow taper.  I thought 1mg/fortnight would be OK but it turned out it wasn't, when I dropped from 3mg-2mg the withdrawals were intense, vertigo, impending doom, ear ringing, blood pressure changes, palpitations, felt like passing out, etcetc. 

 

I decided to just stick at 2mg and the worst of the withdrawals had lasted about a month, now I have constant anxiety and brain fog/retardation and it's really affecting my relationships and schooling.  

 

I'm going to do bead counting 1/fortnight but first I need to stabilise.  Is it OK to reinstate a higher dose? It has been 2 months since my last drop.  


#2 invalidusername

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Posted 25 September 2021 - 06:23 AM

Hey Troy,

 

By alternating dose method, I assume you mean 30mg/60mg to get 45mg or similar? Glad you got through this... so then you reached 30mg and slowed to 1mg drop at a time. Fair choice,

 

What you need to remember is that the drop from 30mg to 29mg is a drop of 3%, a drop from 3mg to 2mg is 33%... over 10 times worse! This is why a bead court is better. You start removing 10 beads at 30mg and reduce the amount of beads as the dose lowers, that way the % drop remains the same. 

 

If you are stuck with these symptoms, go back to 3mg, stabalise and bead count. You will be fine to return to 3mg as your last stable dose, but you may find that 2.5mg is sufficient. You may want to calculate the amount of beads to get you to 2.5mg and give that 3-5 days. If there is no suitable improvement, ramp it up to 3mg and hopefully that should get you on the straight and narrow again. 

 

Please feel free to ask any questions - we are here to help any way we can

 

IUN


#3 fishinghat

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Posted 25 September 2021 - 08:17 AM

Got to go with iun here. Even though your taper may seem slow it was still too fast for to  handle. 

 

 

it would not be uncommon for many to stay at your current symptom levels for a few months before improving so i would say that increasing the dose a little would be a good idea. Once stable then do the beadcounting. Some have had to go as slow as 1 bead dropped per week. Lets hope you do better than that.


#4 Troypants

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Posted 25 September 2021 - 07:46 PM

Hey guys, thanks for the quick reply.

 

Yeah I didn't realise the withdrawals until that drop from 3mg-2mg, I would have been feeling the previous drops to some degree but I didn't put 2 and 2 together until that last drop. 

 

I have been on duloxetine for 10-15 years and have experience with other drug withdrawal before, so I was bound to have to deal with a drawn out taper, I just didn't realise how powerfully addictive this drug is.

 

I am taking 1 dose of 2mg in the morning at the moment, I added a couple of beads in the afternoon yesterday, I was thinking it would be better to do 2 doses to keep the blood levels stable, but it does add an extra complexity to the taper.

 

Do you think instead it would be better to just add some beads to the capsules I have made to take it back to 2.5mg? I'll see how that goes before I goto 3mg.

 

13 beads is 2mg duloxetine according to my calculations, so about 16/17 beads would be 2.5mg


#5 invalidusername

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Posted 26 September 2021 - 05:38 AM

Hi Troy,

 

Calculations are correct. 1mg = 6.5 beads.. multiply by 2.5 give you 16.25 - always round up and you have 17 beads. Give this around 3-5 days for levels to balance out and if nothing improves by then, it isn't going to, so up the last few beads and hopefully this will be enough.

 

Just add some beads where you have them, but make sure you make a note of which capsules are which - or better yet, just have a stockpile of beads and make your 5 capsules of 2.5mg so you know how far through you are. It is so easy to forget how many days you have take a given dose! 

 

Some find that splitting the dose 12 hours apart makes the final few beads easier to come through - so this is also an option. Given the short half life this means that you are never running on less that 50% serum level. But if you find that your post-12 hour times aren't too bad then stick to once a day.

 

Let us know how you go...

 

IUN


#6 Troypants

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Posted 26 September 2021 - 08:58 PM

Awesome thanks IUN, I've added the 2 beads for the week and see how that goes. If I need more I will add another 2 beads next week to make 17 beads.  I've been pretty good for the most part but I went camping and it must have been a bit much for my brain to cope with... Or maybe it was just a shitty wave. 

 

I'll stick with the 1 dose a day for the moment, if I find it hard to function by the end of the day I may split into 2 doses.

 

So to conclude,

 

I am on 15 beads/day for 1 week to try, if I need more I will raise to 17 beads next week.

 

I use a 7day medication pack so it makes it easy to tell how many doses I have taken.

 

Thanks!


#7 invalidusername

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Posted 28 September 2021 - 05:24 PM

Sounds like a good plan - the more you add on, inevitably, the more you will have to taper from later, but make sure that you see yourself to a point where you can stomach the withdrawal.

 

A week on that dose will certainly tell you whether or not you need to add the extra beads or not. But do not worry if you have to - you already know you have gone quite quick to this point.


#8 Troypants

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Posted 11 October 2021 - 02:34 AM

So, 2 weeks since I added 2 beads. I had a nice window for about a week then back into a shitty wave. I'm still in the wave now with anxiety, little bit of ear ringing and weird blood pressure stuff, cloudy head, can't think properly. Its not as bad as it has been but its still there.

I guess these waves become less intense and shorter as time goes on, the windows are awesome, its great to feel relatively normal for a short while.

I'll just keep going with my 15 beads for the moment, see how it goes. If I need to I can always add some because I will be tapering 1 bead per fortnight when I actually feel normal again so I hopefully don't get any withdrawals.

#9 fishinghat

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Posted 11 October 2021 - 06:11 AM

Slow but steady wins the race.


#10 invalidusername

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Posted 12 October 2021 - 07:37 PM

Slow but steady wins the race.

 

Exactly what I would have said, but I am quite sure I have to pay royalties to Hat when I do :D


#11 Troypants

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Posted 16 October 2021 - 04:46 PM

Haha, yeh I wish I had known how slow I need to go.

I had full body numbness while trying to sleep last night, very disturbing and it took me a while to pass out.

I have had it before, its hard to say if its an effect of the cymbalta withdrawal or something else because I've been tapering down on and off for a long time. It seems like it is an effect of the withdrawal though.

#12 invalidusername

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Posted 21 October 2021 - 04:04 PM

Hopefully, this will pass soon enough for you if it is in fact a result of the withdrawal.

 

Please feel free to let us know how you are getting on, and whether we can offer any more advice - we are here if you need us...

 

IUN


#13 Troypants

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Posted 29 October 2021 - 02:39 AM

Hey guys, I haven't had the body numbing effect since that time.

I have done a few days at the lab at uni, the first time in ages I have had to be around people for an extended period of time. It was nice to be around people but torturous at the same time, trying to keep myself from giving off signals and not look miserable. I would have enjoyed it if I wasn't going through this. And my marks are going to suffer too.

I have an excerpt from wikipedia I would like you guys to look at, maybe you have some ideas on it?
----------------------------------------------

Autoreceptors Edit
5-HT1A receptors can be located on the cell body, dendrites, axons, and both presynaptically and postsynaptically in nerve terminals or synapses. Those located on the soma and dendrites are referred to as somatodendritic, and those located presynaptically in the synapse are simply referred to as presynaptic. As a group, receptors that are sensitive to the neurotransmitter that is released by the neuron on which the receptors are located are known as autoreceptors; they typically constitute the key component of an ultra-short negative feedback loop whereby the neuron's release of neurotransmitter inhibits its further release of neurotransmitter. Stimulation of 5-HT1A autoreceptors inhibits the release of serotonin in nerve terminals. For this reason, 5-HT1A receptor agonists tend to exert a biphasic mode of action; they decrease serotonin release and postsynaptic 5-HT1A receptor activity in low doses, and further decrease serotonin release but increase postsynaptic 5-HT1A receptor activity at higher doses by directly stimulating the receptors in place of serotonin.
----------------------------------------------

Note the biphasic properties of 5HT1A receptor agonists, maybe reuptake inhibitors have a similar pharmacodynamic?

I am on about 2.5mg duloxetine at the moment and I'm just wondering if I am making things worse.... Maybe I should continue dropping completely off?

Also, how long do people normally take to come good? It is 4 months for me

#14 Troypants

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Posted 29 October 2021 - 03:35 AM

4 months since I paused dropping**

#15 fishinghat

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Posted 29 October 2021 - 08:35 AM

That is a very good and detailed explanation of those receptors. There are a couple things to consider. First of all there are around 6 other serotonin receptors in the body that also effect serotonin levels, there are several different protein transporters involved as well and several gut probiotics that also manufacture serotonin and release it into the digestive tract. All of this makes it very difficult to predict or control serotonin levels. 

 

As far as your comment about "biphasic properties of 5HT1A receptor agonists, maybe reuptake inhibitors have a similar pharmacodynamic?"  I do believe this is quite possibly true but the dynamics of serotonin performance and the mechanism of ssri/snri action need a lot more study for sure.

 

When bead counting I would say that most take 2 to 6 months to stabilize when pausing their wean. Having said that, I would also say there is a lot of variability in those numbers. I can tell you that going ahead with the wean before stabilizing is almost always a recipe for disaster. Those last few mg are the most difficult.

 

Are you having a daily pattern to your withdrawal symptoms? Like better in the mornings and worse in the evenings? If there is a daily cycle like that then sometimes it helps to even out your Cymbalta dose during the day. Such as taking half your beads in the morning and half in the evening.

 

Also, you might consider keeping a log of your worst symptom, such as anger. Write down how many hours each day you suffer that symptom and after a couple weeks you can look at that data and tell if you are improving and how fast. Some things people have tracked is a specific emotion, sleep or how many hours you feel well or really bad each day. It is almost impossible to trust your gut feelings while going through withdrawal. When you feel better you think all is going to be alright and when you feel bad you feel like you will never feel good again. By keeping a log you minimize the effects of "unsure" thinking caused by the withdrawal.

 

I know how hard it is to be patient but hang in there. Things will get better.


#16 Troypants

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Posted 30 October 2021 - 01:12 AM

Haha

"When you feel better you think all is going to be alright and when you feel bad you feel like you will never feel good again."

That is spot on.

Yeah, maybe I will just do that, split the dose up. I was going to a while back but I didn't. I will do that after my labs I think just in case I have some kind of crazy reaction to the change, I have one day left next Wednesday so after that I don't have to be around people if something happens.

I wasn't bead counting previously, I was dropping by 1mg per fortnight so it might take a bit longer to stabilise, but I will definitely be bead counting from now on.

My symptoms range from moderately anxious with a little ear ringing at night time on good days. To ear ringing, malaise, inhibiting social anxiety, throbbing in the middle of the head, weird head rushes. The apparent blood pressure irregularities can still be there from time to time but not as bad as it was.

I did add a bead while I did my labs last week for 3 days so that may have destabilised me a little when I put it back down again.

Overall it is better than it was 3 months and even 2 months ago. Its just seems so slow it feels like it couldn't be possible for it to still be from withdrawal.

That being said, I used to take MDMA pills back in the day on the weekend when I was younger and more stupid, and it would take a month to feel relatively back go normal, and that was from one night of use. CNS serotonin transmission seems to be a very fragile system.

#17 invalidusername

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Posted 31 October 2021 - 09:02 AM

Hi Troy,

 

Hat has that covered perfectly in saying that whilst the wiki entry, whilst is correct, this really depends on the situation. What it states in the above will change depending on the circumstances, and specifically the medication involved. This is just one part to an otherwise diverse recipe. Furthermore, this action will be open to subjectivity. Not all will have the same level of response than another. 

 

MDMA will of course mess things up!! But you at least understand. Again, it can be very different from one person to another. I have tried all manner of different "solutions" to my mental health problems and there can be some very strange effects indeed! And the subjectivity element should never be downplayed which is why when people talk about too much Googling of the reactions, this makes sense purely from this perspective. The brain, let alone individual receptors, are so unique, it is only the experience which will tell you the true reaction that will befall your own system.

 

IUN


#18 Troypants

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Posted 12 November 2021 - 02:26 AM

I've been using l-theanine 200mg twice a day for the last few days, it seems to help I'm just worried about it causing dependency.

Does anyone know if it causes dependency with chronic use?

I have only used 100mg today, but I switched the dose of my cymbalta.

Instead of using 13 beads in the morning and adding 2 beads later at 2pm, I decided to change to use 8 beads in the morning and 8 beads at midday. Either the change in dose arrangement or the lowered l-theanine has given me a bit of setback and anxiety this afternoon.

#19 fishinghat

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Posted 12 November 2021 - 08:48 AM

I can find no research showing any chance of L-theanine causing dependance or withdrawal. A great many members have used L-theanine and none have reported any issues with either dependance or withdrawal. I would say the drop in quality of life is probably due to the lower L-theanine dose.

 

The change in Cymbalta dose is a smart one. It should help minimize mood swings some.

 

Keep up the good work, you will get there.


#20 Troypants

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Posted 12 November 2021 - 11:06 PM

Thanks hat, for the most part it is getting better its just such a bloody long process..

I'm having today off the L-Theanine, I had what felt like a rebound effect last night. I got panic and high blood pressure as I was going to bed. I have abused phenibut in the past and I know that just because something is an amino acid doesn't mean that it cant cause horrible withdrawal symptoms.

Do you know much about n-acetyl-cysteine for withdrawal? I can't find much info on it and its hard to search for because people put it in their signature and "NAC" is not allowed as a search term.

#21 fishinghat

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Posted 13 November 2021 - 08:30 AM

I have used NAC extensively during my benzo withdrawals. I can't say it is a cure but it did help some. My efforts during my Cymbalta withdrawal did not show any benefit. Have you checked the info in our ebook? I seem to remember a section in there on NAC.


#22 fishinghat

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Posted 13 November 2021 - 08:49 AM

N-Acetylcysteine withdrawal - Search Results - PubMed (nih.gov)

 

You might find some of these abstracts helpful from the government abstracting service.


#23 invalidusername

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Posted 13 November 2021 - 07:14 PM

Just echoing Hat's comments - levelling out your beads to an even spread over the day was a good move, but it WILL take around 3-5 days for the plasma levels to balance out. But it should help you in the long run.

 

I am with you in the Phenibut. Had some crazy experiences with that - take a look at my post;

 

https://www.cymbalta...onary-response/

 

I also know of no issues with dependancy of theanine. This is why it was favoured by primary docs and GP's before Eli Lilly came along and messed things up with Prozac. 

 

Anything regarding NAC - Hat is your man. He has done extensive research into that - so take his advice as gospel.


#24 Troypants

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Posted 14 November 2021 - 04:09 AM

Awesome thanks guys!

I think maybe its just the plasma level from the dosage timing that's giving me grief, like you said IUN. And Im hypersensitive to any change. I will wait till i stabilise and then try the l-theanine again.

I'll have a look at those links you sent me too. And possibly hop on the acetylcysteine!

I haven't looked through the book because its so many pages haha, I've probably read that many pages though just searching on the web and on here so I will just start reading a couple of pages a day.

#25 Troypants

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Posted 14 November 2021 - 04:20 AM

And yeah, phenibut was absolutely horrific, I thought I was dying everyday for about a month and then just anxious and shit for the next year+.

#26 Troypants

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Posted 15 November 2021 - 01:49 AM

Hey hat, is there any SSRI specific research on NAC? I was also hoping for some anectodal evidence, do you have personal experience using it, or have you seen much success on the board?

#27 fishinghat

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Posted 15 November 2021 - 08:00 AM

I tried NAC several times during my Cymbalta withdrawal but had no success.

 

This is from the ebook....

 

NAC - N-acetylcysteine - Strong antioxidant.
 
NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.
 
the study provides only limited support for the role of NAC as a novel adjunctive therapy for MDD. 
 
These open label data demonstrate a robust decrement in depression scores with NAC treatment
 
There were no significant between-group differences in recurrence or symptomatic outcomes during the maintenance phase of the trial;
 
The anxiolytic effects of NAC were comparable to diazepam. 
 
 
modulation of Glu transporter expression may restore Glu (Glutamate) homeostasis.
 
These studies evaluated the role of NAC (N-acetylcysteine) in cocaine dependence (three studies), c******* dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled.
The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and c******* dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction.
 
Furthermore, NAC was able to rescue changes in key glutamate receptor proteins related to excitotoxicity in HD, including NMDAR2B. Thus, we have shown that baseline reductions in cysteine underlie glutamatergic dysfunction and depressive-like behavior in HD and these changes can be rescued by treatment with NAC. These findings have implications for the development of new therapeutic approaches for depressive disorders.
 
NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.
 
the study provides only limited support for the role of NAC as a novel adjunctive therapy for MDD.
 
These open label data demonstrate a robust decrement in depression scores with NAC treatment
 
There were no significant between-group differences in recurrence or symptomatic outcomes during the maintenance phase of the trial;
 
The anxiolytic effects of NAC were comparable to diazepam. 
 
 
Interactive effects of N-acetylcysteine and antidepressants
 
Treatment with Adjunctive N -Acetylcysteine in an Adolescent with Selective Serotonin Reuptake Inhibitor-Resistant Anxiety
 
The effect of N-acetylcysteine on oxidative serum biomarkers of hemodialysis patients
"The study period was set at 6 months, during which time patients received oral 600 mg of NAC, twice daily before meals. "
"Administration of NAC was correlated with significant changes in haemoglobin levels (p=0.029), a decrease in leukocyte count (p=0.002), in particular, neutrophil percentage (p=0.001) while lymphocytes rose (p=0.008). "
 
In addition, the FDA database states that 1.4% of those taking N-acetycysteine develop leucopenia within a month.
Members Comments
 
FH - You know, something you may try is this N-Acetylcysteine at 500 or 600 mg twice a day. I have been impressed with its help (benzo withdrawal). Not a huge improvement but a consistent and noticeable improvement. I notice some relief starting around an hour after taking it and it lasts for about 3 or 4 hours.
 
Freeme - I have been taking milk thistle to detox the liver and zertex. I put benadryl spray on my arms at night. I am taking also x3 NAC which cleanses the liver too. These both will calm down my itchy to nothing. 
 
Dr. xxxxxxx - This may be an issue as the blood parameter changes noted in this study resemble my changes in blood chemistry. I am currently taking 600 mg once daily.
 
FH - The main factor has been the 600 mg of N-acetylcysteine(NAC) I have been using every other day (for benzo withdrawal). On the day I use it I can feel a noticeable improvement of around 50% in my symptoms. I would like to mention to everyone that my symptoms are minimal at this slow a drop rate, not comparable to Cymbalta withdrawal. As soon as I feel stable I will go to taking the NAC daily and then if stable I will drop a little faster again. The main factor has been the 600 mg of N-acetylcysteine(NAC) I have been using every other day. On the day I use it I can feel a noticeable improvement of around 50% in my symptoms. I would like to mention to everyone that my symptoms are minimal at this slow a drop rate, not comparable to Cymbalta withdrawal. As soon as I feel stable I will go to taking the NAC daily and then if stable I will drop a little faster again.
One thing I wanted to point out from the research is that it has a direct effect on Glutamate, the main excitatory neurotransmitter. It modulates its blood concentration. Modulates means that if levels are high it lowers them and if levels of glutamate are low it raises them. So essentially the glutamate levels are keep in a relatively stable middle of the road concentration. This is important because glutamate control GABA production. GABA is the main calming neurotransmitter that does the primary blocking of synapses when not in use. So by stabilizing the glutamate production you also stabilize the GABA production.
 
DThiessen - forgot to mention I am also taking NAC OTC 600mg daily. Really seems to help with basically every withdrawal symptom. 
 
Mxpro - I've been taking nac for a few days and it seems to really be helping. I swear it's helping me to ruminate less and my mood seems better.
 

#28 Troypants

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Posted 16 November 2021 - 02:19 AM

Well, I used 600mg NAC this morning and afternoon and it sure does make a noticeable difference. Same with l-theanine, I am just frightened that there will be some kind of rebound

#29 Troypants

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Posted 16 November 2021 - 03:29 AM

Although this afternoon I had it on empty stomach. Felt good when I posted that^^ then felt weird after a while, had some dinner and felt better. Now I am a bit spacy but I think I feel better than I would normally, still anxious but not uncomfortable, just anxious around people. I have been getting heart palpitations in the evening recently after I switched to bi-daily dosing of cymbalta (and stopped the theanine). I should have stopped the l-theanine first so I could tell which thing did what.... Oh well.

#30 Troypants

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Posted 16 November 2021 - 03:31 AM

I would like to see some studies on the effect SSRI/SNRIs have on the glutamatergic system because I have a feeling that it is a large one. It would explain the hypersensitivity to everything



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